Nursing

"If you are at all familiar with the dominant vocabulary of American bioethics, you are undoubtedly aware that it is an ethics based on principles, most notably the principles of autonomy, beneficence, justice and nonmaleficence People involved in health care, especially physicians and nurses, are expected to observe rules and rights derived from these general principles to determine what they are morally obliged to do in particular situations. If the principles clash, as they often do, then they must be balanced against each other to determine which one obliged or they must be adjusted to preserve coherence in the system. In the minds of many, making moral decisions and judgments in health care ethics remains a process of guiding our actions in accord with the obligations and rights established by the general principles and the more specific rules derived from them."

"In a world where there is so much to be done, I felt strongly impressed that there must be something for me to do."

"When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness. It changed the way I saw life. For months, I didn’t know who I was or whether I would live or die. The doctors had no idea whether I’d make it either. I remember hugging my mother and saying, “Just tell me if I’m going to die.” I was in the second year of training for the priesthood in the diocesan seminary of Buenos Aires. I remember the date: Aug. 13, 1957. I got taken to a hospital by a prefect who realized mine was not the kind of flu you treat with aspirin. Straightaway they took a liter and a half of water out of my lungs, and I remained there fighting for my life. The following November they operated to take out the upper right lobe of one of the lungs. I have some sense of how people with Covid-19 feel as they struggle to breathe on a ventilator. I remember especially two nurses from this time. One was the senior ward matron, a Dominican sister who had been a teacher in Athens before being sent to Buenos Aires. I learned later that following the first examination by the doctor, after he left she told the nurses to double the dose of medication he had prescribed — basically penicillin and streptomycin — because she knew from experience I was dying. Sister Cornelia Caraglio saved my life. Because of her regular contact with sick people, she understood better than the doctor what they needed, and she had the courage to act on her knowledge. Another nurse, Micaela, did the same when I was in intense pain, secretly prescribing me extra doses of painkillers outside my due times. Cornelia and Micaela are in heaven now, but I’ll always owe them so much. They fought for me to the end, until my eventual recovery. They taught me what it is to use science but also to know when to go beyond it to meet particular needs. And the serious illness I lived through taught me to depend on the goodness and wisdom of others."

"Bound by paperwork, short on hands, sleep, and energy... nurses are rarely short on caring."

"Murder by Proxy.-“There is at the present time, a kind of infanticide, which, although it is not so well known, is even more dangerous, because done with impunity. There are parents who recoil with horror at the idea of destroying their offspring, although they would greatly desire to be disembarrassed of them, who yet place them without remorse with nurses who enjoy the sinister reputation of never returning the children to those who have untrusted them to their care. These unfortunate little beings are condemned to perish from inanition and bad treatment. “The number of these innocent victims is greater than would be imagined, and very certainly exceeds that of the marked infanticides sent by the public prosecutor to the Court of the Assizes.”"

"It is needless to recapitulate all the causes of unchastity which have previously been quite fully dwelt upon, nearly all of which are predisposing or exciting causes of solitary as well as of social vice. Sexual precocity, idleness, pernicious literature, abnormal sexual passions, exciting and irritating food, glutton, sedentary employment, libidinous pictures, and many abnormal conditions of life, are potent causes in exciting the vile practice; but by far the most frequent causes are evil associations, wicked or ignorant nurses, and local disease, or abnormality. These latter we will consider more particularly, as they have not been so fully dwelt upon elsewhere."

"Wicked Nurses.-In those cases in which the habit is acquired at a very early age, the work of evil is usually wrought by the nurse, perhaps through ignorance of the effects of the habit. Incredible as it seems, it is proved by numerous instances that it is not an uncommon habit for nurses to quiet small children by handling or titillating their genital organs. They find this is a speedy means of quieting them, and resort to it regardless or ignorant of the consequences. Not an Uncommon Case.-Prof Lusk of Bellevue Hospital College, New York, related to his medical class in our hearing a case which came under his observation in which all of the children in a large family had been taught the habit by a wicked nurse for the purpose of keeping them quiet after they were put to bed. The vileness that would lead a person to thus rob childhood of its innocence, and blast its prospects for this life and the next, is base enough for the commission of almost any-crime. Indeed, the crime could hardly have been a worse one had the nurse referred to in the above case in cold blood cut the throats of those innocent children ; perhaps it might have been better for the children."

"By the early 1890s nurses had begun seriously to discuss ethical issues in nursing. In 1899 the International Council of Nurses was established, professional journals, such as “The American Journal of Nursing”, sprang up and in 1901 Isabel Hampton Robb, a leader of nursing at the time, wrote one of the first books on nursing ethics, entitled Nursing Ethics for Hospitals and Private Use(Robb 1901). The vast majority of nurses are women and, until fairly recently, the vast majority of doctors have been men. Not surprisingly, the relationship between doctors and nurses reflected the different roles of women and men, and their relative status in society. One of the manifestations of this was the assumption that the primary responsibility of nurses was to doctors rather than to patients, and that nurses had to show absolute obedience to their medical colleagues. As one American nursing leader put it in 1917: “The first and most helpful criticism I ever received from a doctor was when he told me that I was supposed to be simply an intelligent machine for the purpose of carrying out his order”(Dock 1917: 394). The view that the nurse’s primary responsibility was to the doctor prevailed until the 1960s, and was still reflected in the 1965 version of the International Code of Nursing Ethics. Item 7 of the Code states: “The nurse is under an obligation to carry out the physician’s orders intelligently and loyally.” The revival of feminist thinking in the late 1960s paralleled the developing self-consciousness and self-assertiveness of nurses, and in the 1973 International Council of Nurses’ Code for Nurses, the nurse’s “primary responsibility” is no longer seen to be to doctors but to patients – “to those people who require nursing care.” This questioning by nurses of their traditional role and their relationship with doctors and patients eventually converged with a movement by feminist philosophers that challenged the traditional (and therefore male-dominated) view of ethics as a matter of abstract, impartial, and universal principles or rules. Instead of this conception of ethics, feminist philosophers like Nel Noddings (1984) conceived of ethics as a fabric of care and responsibility arising out of personal relationships. Building on this“female” approach to ethics, both philosophers and nurses sought to construct a new ethics for nurses based on the concept of care. Jean Watson, a nurse and a prominent proponent of a nursing ethics of care, applies to the nursing situation Noddings’s view that an ethics of care “ties us to the people we serve and not to the rules through which we serve them” (Watson 1988: 2)."

"I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient."

"No man, not even a doctor, ever gives any other definition of what a nurse should be than this — "devoted and obedient." This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman."

"It is as impossible in a book to teach a person in charge of sick how to manage, as it is to teach her how to nurse. Circumstances must vary with each different case. But it is possible to press upon her to think for herself."

"Save one life... and you are a hero. Save one hundred lives... and you are a nurse."

"A hero is someone who happened to be in the right circumstances and took the action of great humanity. A nurse is someone who took the action of great humanity and chose to be in the right circumstances."

"I think the biggest lesson is that we can’t predict what influenza will do. In villages in Alaska, for example, the whole village would become sick at once. There would be nobody to provide food, nobody to provide shelter—these things can a make a difference. And even in wealthy nations like the United States, the conclusion at the end of 1918 and 1919 was that the single most important thing that could save your life from flu was good nursing care. Not medicines, not doctors, not hospitals, but good nursing care. When you first read those things you’re likely to say, “That can’t be true, what could they do in those days?” You know, what’s chicken soup going to do? What’s a blanket going to do? I believe the data, they’re strong, and some of the best and smartest physicians, nurses, and other observers said it again and again, "good nursing care.""

"Likewise we hold in the highest esteem those doctors and members of the nursing profession who, in the exercise of their calling, endeavor to fulfill the demands of their Christian vocation before any merely human interest. Let them therefore continue constant in their resolution always to support those lines of action which accord with faith and with right reason. And let them strive to win agreement and support for these policies among their professional colleagues. Moreover, they should regard it as an essential part of their skill to make themselves fully proficient in this difficult field of medical knowledge. For then, when married couples ask for their advice, they may be in a position to give them right counsel and to point them in the proper direction. Married couples have a right to expect this much from them."